UBC Research Data

Post-discharge mortality among children under 5 years admitted with suspected sepsis in Uganda: a prospective multi-site study ~ Smart Discharges Wiens, Matthew O; Bone, Jeffrey N; Kumbakumba, Elias; Businge, Stephen; Tagoola, Abner; Sherine, Sheila Oyella; Byaruhanga, Emmanuel; Ssemwanga, Edward; Barigye, Celestine; Nsungwa, Jesca; Olaro, Charles; Ansermino, J Mark; Kissoon, Niranjan; Singer, Joel; Larson, Charles P; Lavoie, Pascal M; Dunsmuir, Dustin; Moschovis, Peter P; Novakowski, Stefanie; Komugisha, Clare; Tayebwa, Mellon; Mwesignwa, Douglas; Knappett, Martina; West, Nicholas; Nguyen, Vuong; Mugisha, Nathan-Kenya; Kabakyenga, Jerome


<br /><strong>Background:</strong> Substantial mortality occurs after hospital discharge in children under 5 years old with suspected sepsis. A better understanding of its epidemiology is needed for effective interventions aimed at reducing child mortality in resource limited settings. <br /> <br /><strong>Methods:</strong> In this prospective observational cohort study, we recruited 0-60-month-old children admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. The primary outcome was six-month post-discharge mortality among those discharged alive. We evaluated the interactive impact of age, time of death, and location of death on risk factors for mortality.<br /> <br /><strong>Findings:</strong> 6,545 children were enrolled, with 6,191 discharged alive. The median (interquartile range) time from discharge to death was 32 (10-92) days, with a six-month post-discharge mortality rate of 5·5%, constituting 51% of total mortality. Deaths occurred at home (45%), in-transit to care (18%), or in hospital (37%) during a subsequent readmission. Post-discharge death was strongly associated with weight-for-age z-scores < -3 (adjusted hazard ratio [aHR] 5·05; 95%CI: 3·97-6·43), referral for further care (aHR 8·81; 95%CI 6·43-12·06), and unplanned discharge (aHR 3·23; 95%CI 2·52-4·15). The hazard ratio of those with severe anaemia increased with time since discharge, while the hazard ratios of discharge vulnerabilities (unplanned, poor feeding) decreased with time. Children with severe anaemia (<7 g/dL) died 35 days (95%CI 19·4-51·9) later than those without anaemia. Age influenced the effect of several variables, including anthropometric indices (less impact with increasing age), anaemia (greater impact), and admission temperature (greater impact).<br /> <br /><strong>Data Collection Methods:</strong> All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge.<br /> <br /><strong>Abbreviations:</strong><br /> MUAC -mid upper arm circumference<br /> wfa – weight for age<br /> wfl – weight for length<br /> bmi – body mass index<br /> lfa – length for age<br /> abx - antibiotics<br /> hr – heart rate<br /> rr – respiratory rate<br /> antimal - antimalarial<br /> sysbp – systolic blood pressure<br /> diasbp – diastolic blood pressure<br /> resp – respiratory<br /> cap - capillary<br /> BCS - Blantyre Coma Scale<br /> dist- distance<br /> hos - hospital<br /> ed - education<br /> disch - discharge<br /> dis -discharge<br /> fu – follow-up<br /> pd – post-discharge<br /> loc - location<br /> materl - maternal<br /> <br /><strong>Ethics Declaration:</strong> This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (No. 15/10-16), the Uganda National Institute of Science and Technology (HS 2207), and the University of British Columbia / Children & Women’s Health Centre of British Columbia Research Ethics Board (H16-02679). This manuscript adheres to the guidelines for STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).; <br /><strong>NOTE for restricted files:</strong> If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. <br />Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab."

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